Practice Transformation: A Personal History

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1 Practice Transformation: A Personal History ehealth Initiative: Connected Communities Learning Forum April 10, 2006 Joe Heyman, MD Secretary, American Medical Association

2 Influences Bridges to Excellence (Employers, Providers, Plans) P4P DOQ-IT AHRQ Massachusetts ehealth Collaborative

3 Progress Great software and hardware Clinician comfort with computers and internet Easy set up of hard wired and wireless networks

4 Paper Problems Phone calls Appointments Changing Demographics Problem Lists

5 Paper Problems Medication Lists Record Requests Reports Prescriptions by phone and in office Checkout and billing

6 Paper Problems Unreadable Tiny writing on charts Lost and scattered data Wrong office

7 Think about this! Your Practice Exam MD Room Office Front Office Back Office

8 Paper Problems As much as $16 per chart pull?

9 Disturbing Concerns Our experiences in practice include Incomplete information Alarming error rates Expense of time, energy, and money seemingly way out of proportion to benefits Decisions based on gut or tradition Malpractice claims that are related to documentation some 90% of the time

10 HIT Happens! January 2001 April 2001 Fear Courage

11 Why EMR a must for me Cost Efficiency Image

12 When? Immediately!

13 Why? Cost Office Equipment Rent Employees Patient notification Reassurance to patients Up to date Unique

14 Who? Google Tom Sullivan Jeannie Marcus Massachusetts Medical Society Michael Kelly PIAM

15 What? My Software Desktops Scanner Laser Printer Medem Library of info Encrypted PC Anywhere

16 How? Bo! Network Router DSL Clearinghouse

17 Disaster! March 5, 2002 A day that shall live in infamy! The Agony Paper... yuch! A hard day s night Cynthia ActionFront.com The Cuban Missile Crisis, October 26 and 27, 1962 Office Insurance The Ecstasy

18 More recent major setback Hard Drive Failure in a RAID system 2/06 What happens with your service contract Next steps

19 This Weekend!!!! Laptop drive failure No Medem No way to contact my office computer No way to write this speech

20 My System Digital filing of everything EOBs Contracts Invoices Receipts Correspondence CME certificates Fee Schedules

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26 My System E-prescribing

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29 My System Website (Medem) Interactive Health Record Appointments Prescription refills Online Consultations

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33 My System Banking and Paying Bills

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37 My System Payroll

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39 My System Scheduling

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42 My System Medical Record

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47 My System Billing

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54 My System Electronic record Scheduling Documenting Receiving reports Scanning Coding Billing

55 How much? Somewhere between $15,000 and $30,000 per physician on initial purchase including setup software and hardware. Return on investment usually within two years. Maintenance fees of about $3000 to $9000 per physician

56 How much? Other choices Buy and run remotely Subscribe and run remotely

57 Performance Transcription Elimination Reduced paper management (chart pulls) More usable office space per square foot Error-free legible prescriptions Improved coding

58 Performance Lab Interfaces Referral Management Guideline Compliance Quality Reporting Search by diagnosis, procedure, drug

59 Performance Increased office efficiency Patients happiness Lower costs Accessibility

60 Lessons Learned Do it now! Hardware a bargain! Software increasingly more robust and expensive Many fantastic EMRs available One patient at a time Don t duplicate paper world

61 Lessons Learned Before you decide on anything, understand where you are today. Tour your practice and make sure you understand it all. Find out all the irritants you and your staff endure in the paper world. The worst thing you can do is recreate your present environment electronically!

62 Lessons Learned Make sure the system you choose gets rid of as many of those irritants as possible. Visualize your future state before you decide. It s just software and it s constantly changing. It isn t perfect.

63 Lessons Learned Correlation between a particular vendor and success is not as important as the correlation between the office culture and success. Once you understand that, selection of vendor can be quick and easy. Most people don t use all the capabilities of their software.

64 Lessons Learned Connectivity will soon be very important. Every physician will use an EMR in less than a decade. The Electronic Health Record is a constantly changing organism with standards still developing.

65 Lessons Learned Consider the advantages and disadvantages of system in your own office on your own server. Consider the advantages and disadvantages of system on the web. Company and support more important than software.

66 Lessons Learned Workflow more important than nifty features. Use available resources. Get help from knowledgeable friends. You need a champion.

67 Lessons Learned It s great fun and exciting. It gives you more freedom, income, and joy in practicing.

68 Lessons Learned Backup! Backup!! BACKUP!!!

69 Lessons Learned Don t underestimate the value of joining and supporting your county, state, specialty society and, of course... The American Medical Association Together we are stronger!

70 Joe Heyman

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